Healthcare Provider Details

I. General information

NPI: 1841856721
Provider Name (Legal Business Name): JUTTA NEMEC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MEADOW PL
OLD GREENWICH CT
06870-2114
US

IV. Provider business mailing address

9 MEADOW PL. N/A
OLD GREENWICH CT
06870-2114
US

V. Phone/Fax

Practice location:
  • Phone: 203-637-3546
  • Fax:
Mailing address:
  • Phone: 203-637-3546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15789
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: